2/6/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS February 6, - - PDF document

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2/6/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS February 6, - - PDF document

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2/6/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS February 6, 2019 Preventing Metabolic Adaptation During Weight Loss Moderator: Lisa Diewald MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education Nursing

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COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS February 6, 2019

Preventing Metabolic Adaptation During Weight Loss

Moderator: Lisa Diewald MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education

Nursing Education Continuing Education Programming Research

FINDING SLIDES FOR TODAY’S WEBINAR www.villanova.edu/COPE Click on Miller/Mull webinar description page

DID YOU USE YOUR PHONE TO ACCESS THE WEBINAR?

If you are calling in today rather than using your computer to log on, and need CE credit, please email cope@villanova.edu and provide your name so we can send your certificate.

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OBJECTIVES

  • Identify methods of assessment necessary to design a

nutrition plan for fat loss.

  • Create a macronutrient prescription to fuel activity and

preserve lean body mass while in calorie deficit

  • Design a sample resistance training workout designed for

simultaneous fat loss and muscle growth.

CE DETAILS

  • Villanova University College of Nursing is accredited as a provider of

continuing nursing education by the American Nurses Credentialing Center Commission on Accreditation

  • Villanova University College of Nursing Continuing Education/COPE

is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration CE CREDITS

  • This webinar awards 1 contact hour for nurses and 1 CPEU for

dietitians

  • Suggested CDR Learning Need Codes: 2070, 2110, 3030, 5370
  • Level 2
  • CDR Performance Indicators: 4.1.2, 4.2.6, 4.2.7, 6.2.3
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PREVENTING METABOLIC ADAPTATION DURING WEIGHT LOSS Todd Miller, PhD, CSCS*D, TSAC-F, FNSCA Stephanie Mull, MS, RD, CSSD, CSCS George Washington University Weight Management Lab Milken Institute School of Public Health Washington, DC

DISCLOSURE Neither the planners or presenter have any conflicts of interest to disclose. Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity.

Preventing Metabolic Adaptation During Weight Loss

Todd Miller, PhD, CSCS, TSAC-F Stephanie Mull, MS, RD, CSSD, CSCS

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The Conventional Approach to Weight Loss

Cardio Calorie Restriction

Guidelines for Exercise

ACSM

Weight loss -- 150-250 minutes/week

  • f moderate-intensity physical activity

provides only modest weight loss. Greater amounts (ie. >250) provide clinically significant weight loss.

CDC

To lose weight and keep it off: You will need a high amount of physical activity unless you also adjust your diet and reduce the amount of calories you're eating and drinking. Getting to and staying at a healthy weight requires both regular physical activity and a healthy eating plan.

Normal Wt. Loss Response

RMR Body Weight

Metabolic Adaptation

Metabolic Adaptation

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Normal Response

RMR Body Weight

Ideal Response

Metabolic Adaptation

Cardio or Strength Training?

RMR 1500 kcal Workout Workout Workout Day 1 3 5 1800 kcal Cardio Cardio 2 4 6 7

Strength Training Rationale

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  • Obesity is characterized by:

High muscle mass; low muscle quality Decreased muscle function

  • In overweight people, 20%‐30% of weight lost during a weight loss intervention comes from

fat free mass.

Is this loss in FFM obligatory?

Lean Body Mass & Obesity

  • 50
  • 40
  • 30
  • 20
  • 10

10 20 Changes in Fat and Fat Free Mass AVG Fat Loss = 14.6 lbs AVG FFM GAIN = 2.9 N=60 N=15 (25%) lost FFM

Metabolism Based Eating

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Measure Body Composition

Measure RMR

Measured Estimated with Mifflin St. Jeor Estimated with Cunningham RMR 2370 1689 2030 Lifestyle and TEF 300-400 300 300 300 TEE 350-600/hr 400 400 400 TOTAL 3070 2389 2730 Measured Mifflin Cunningham RMR 2370 1809 2030 Activity factor 1.6 1.6 1.6 Total 3792 2894 3248

Daily calorie requirement ranges from 2389 - 3792

41 kcal/kg = 3353

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Percent Deviation from Predicted RMR

What if we PREDICTED

  • Predicted RMR: 2,742
  • Add activity factor of 1.5
  • Subtract 1,000
  • Target calorie intake = 3,113

What we ACTUALLY did

  • Actual RMR = 2,168
  • Calorie Rx = 2,100

Client’s calorie intake = 2,122 Recommended intake (from prediction)= 3,113/day Difference from recommended = -991 Actual Fat Loss = 28 lbs. Change in Fat if fed predicted intake = 29 lb fat gain

Why measuring RMR is critical Client: Kia

Kia RMR initial: 2168 RMR after 6 months: 2214 Fat down 28 lbs LBM up ~9 lbs

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Nutrition Planning

CALORIES

  • General rule:

– Males: at the RMR or up to 10% above – Females: at the RMR or 10-15% below – No lower than 20% below the RMR.

CONSIDERATIONS

  • Current intake
  • Lifestyle activity

– Sedentary vs. active job

  • Structured exercise

– Intensity, duration

  • Fat loss needed

Calorie Prescriptions Based on RMR

  • Initial relative RMR range: -21% to +18%

–

6 were below predicted

  • Calorie intake: 9 within 9% of RMR

– 1 couldn’t hit calorie target

  • (ate 19% below RMR)
  • Repeat relative RMR range:
  • 15% to +37%

–

2 were below predicted

10 clients: 6 males, 4 females

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  • 30
  • 20
  • 10

10 20 30 40

Change in RMR (% of predicted)

initial final

Fat

20% of calories

1 avocado = 23 g 2 Tbsp PB = 14 g 1 oz almonds= 14 g 1 Tbsp olive oil = 13 g 2 Tbsp chia seeds = 9 g 2 Tbsp flaxseeds = 6 g 2 Tbsp hummus = 5 g 1 whole egg = 5 g

  • 1.0-1.4 g/lb FFM during calorie restriction
  • Protein should not be >40% of calories.
  • Focus on lean proteins
  • Challenges: vegetarians and vegans
  • Supplements usually necessary
  • Even distribution among meals for a positive nitrogen balance
  • 10-20 grams after RT

RDA for Protein is Inadequate!

Weijs, P. JM. & Wolfe, R.R. (2015). Exploration of the protein requirement during weight loss in obese older adults. Clinical Nutrition.

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Carbohydrate

Fill in the rest of the calories Supports energy requirements and metabolic needs Not the devil

  • “I don’t eat bananas because they have too much

sugar.”

  • “Carrots have too much sugar.”
  • “I only eat sweet potatoes and quinoa but avoid

bread and pasta because they are too carb dense.”

  • “I try to limit my carb intake throughout the day.” –

said by a client who overeats on carb based snacks

  • r sweets in the afternoon/evening.

Monitoring

  • Food tracking is necessary for long-term compliance and success
  • Self-report of intake not accurate
  • Bias gets progressively larger
  • Mathematical model calculations show a significant reduction in self-reported

calorie deficits over 12 months

  • @month 3, EI -804 kcals/say
  • @month 6, EI -279 kcals/day
  • @month 12, EI -65 kcals/day

Importance of Food Tracking

Guo, J., Robinson, J.L., Gardner, C., & Hall, K.D. (2018). Objective versus self-reported energy intake changes during low-carbohydrate and low-fat diets. Retrieved from https://www.biorxiv.org/content/early/2018/09/20/421321.

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Mary's 15 month results:

July 2017: 189 lbs @ 38% fat, RMR 1558 (-6%) October 2018: 157 @ 17.1% fat, RMR 1771 (+21%) AVG calorie intake:

1st 8 months: 1556 after that: 1957

Total fat loss: 45 lbs Total muscle gain: 13 lbs. Total minutes of cardio: 0

Re-Assessment of the Calorie Goal

s/s of increased RMR

  • Hungry
  • Poor sleep
  • Fatigue esp. during workouts
  • Slowed fat loss
  • LBM loss
  • Cognitive changes

s/s of decreased RMR

  • Satiety
  • Difficulty finishing meals and hitting

nutrient goals

  • Fat gain or slowed fat loss

Decision Map for RMR Reassessment

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Thank You!

Questions? tamiller@gwu.edu smull@gwu.edu

  • Look for an email containing a link to an evaluation. The email

will be sent to the email address that you used to register for the webinar.

  • Complete the evaluation soon after receiving it. It will expire

after 3 weeks.

  • You will be emailed a certificate within 2-3 business days.
  • Remember: If you used your phone to call in, and want CE

credit for attending, please send an email with your name to cope@villanova.edu so you receive your certificate.

TO RECEIVE YOUR CE CERTIFICATE

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Elizabeth Venditti, PhD Assistant Professor of Psychiatry Director of the Diabetes Prevention S upport Center The University of Pittsburgh S chool of Medicine Behavior Change to Prevent Chronic Disease: Psychology in Action

Upcoming FREE Continuing Education Webinar

Wednesday, March 6, 2019 12:00PM - 1:00PM EST

Villanova.edu/cope

QUESTIONS & ANSWERS

Moderator: Lisa K. Diewald MS, RD, LDN Email: cope@villanova.edu Website: www.willanova.edu/COPE